Zin is injected into the anterolateral area of ​​the upper thigh, and for children over 18 months - into the deltoid muscle area.

The refusal to administer the vaccine into the buttock, in addition to the possibility of damage to the nerves and vessels passing in the buttock area, is also motivated by the fact that in children early age The gluteal region consists predominantly of adipose tissue, and the quadriceps femoris muscle is well developed from the first months of life. In addition, the anterolateral region of the upper thigh lacks important nerves and blood vessels.

In children over 2 to 3 years of age, it is preferable to administer the vaccine into the deltoid muscle (midway between the lateral end of the spine of the scapula and the deltoid tuberosity). Injections into the triceps muscle should be avoided due to the possibility of injury to the radial, brachial and ulnar nerves, as well as the deep brachial artery.

Contraindications to vaccination. Contraindications to vaccination are divided into permanent (absolute) and temporary (relative). Absolutely contraindicated:

all vaccines - in case of excessively strong reactions or other post-vaccination complications to the previous administration;

all live vaccines - to persons with immunodeficiency conditions (primary); immunosuppression, malignant tumors; pregnant women;

BCG vaccine - if the child’s body weight at birth is less than 2,000 g; keloid scars, including after administration of the previous dose;

DPT vaccine - for progressive diseases of the nervous system, a history of afebrile convulsions;

live measles, mumps, rubella vaccines - for severe forms of allergic reactions to aminoglycosides; anaphylactic reactions to egg white (except rubella vaccine);

vaccine against viral hepatitis B - for allergic reactions to baker's yeast.

In case of temporary contraindications, routine vaccination is postponed until the end of acute and exacerbation of chronic diseases; the vaccine is administered no earlier than 4 weeks after recovery.

4.6. Vaccine reactions and complications

4.6.1. Vaccine reactions

Normal vaccine reaction. The vaccination process is usually asymptomatic, but in vaccinated individuals there may be

manifestations of a normal vaccine reaction, which is understood as clinical and laboratory changes associated with the specific effect of a particular vaccine. Clinical manifestations and the frequency of their occurrence are described in the instructions for each medical immunobiological drug. Thus, vaccine reactions are a complex of clinical and paraclinical manifestations that stereotypically develop after the administration of a specific antigen and are determined by the reactogenicity of the vaccine.

Pathological conditions during the vaccination process. Along with normal vaccine reaction administration of vaccines may be accompanied side effects. Pathological conditions that arise in the post-vaccination period are divided into three groups: 1) the addition of an acute intercurrent infection or exacerbation of chronic diseases; 2) post-vaccination reactions; 3) post-vaccination complications(discussed in subsection 4.6.2).

Nonspecific infectious diseases. In children, after the administration of vaccines, nonspecific (in relation to the vaccine) infectious diseases may occur: acute respiratory viral infections(ARVI) (often with manifestations of neurotoxicosis, croup syndrome, obstructive bronchitis), pneumonia, infection urinary tract, neuroinfection, etc. As a rule, the increased infectious morbidity in the post-vaccination period is explained by a simple coincidence in the timing of vaccination and illness. However, it may also be associated with changes in the immune system after the administration of vaccines. This is due to the fact that when vaccines are administered, the same type of two-phase changes occur in the immune system.

The first phase - immunostimulation - is accompanied by an increase in the number of circulating lymphocytes, including T-helper cells and B-lymphocytes.

The second phase - transient immunodeficiency - develops 2-3 weeks after vaccine administration and is characterized by a decrease in the number of all subpopulations of lymphocytes and their functional activity, including the ability to respond to mitogens and synthesize antibodies. This phase is necessary to limit the immune response to vaccine antigens. In addition, vaccination also causes changes in the innate immune system: interferon hyporeactivity (starting from the 1st day after vaccination), inhibition of the activity of complement, lysozyme, and phagocytic activity of leukocytes. This restriction, however, applies to antigens that are foreign to the vaccine and unrelated.

Pathogenetically, post-vaccination immunodeficiency is indistinguishable from secondary immunodeficiencies arising during viral or bacterial infections, and it is this that underlies

increased infectious morbidity of non-specific (in relation to the vaccine) infections. In the post-vaccination period, children are more likely to experience various acute infections, with two peaks observed: in the first 3 days and on the 10th -30th day after vaccination.

TO this group also includes complications that develop

V as a result of violation of vaccination technique. Violation of the sterility of vaccines is one of the extremely dangerous ones. This is the reason for the development purulent-septic complications, in some cases resulting in the development of infectious-toxic shock and death.

Pathological post-accinal reactions. Some children experience climatic symptoms during preventive vaccinations.

nic disorders unusual for the normal course of the vaccination process. Such pathological vaccine reactions are divided into local and general.

Local pathological vaccine reactions include all reactions that occur at the injection site vaccines

us. Nonspecific local reactions appear on the 1st day after vaccination in the form of hyperemia and edema, which persist for 24 to 48 hours. When using adsorbed drugs, especially subcutaneously, an infiltrate may form at the injection site. With repeated administration of toxoids, excessively strong local allergic reactions may develop, spreading to the entire buttock, and sometimes involving the lower back and thigh.

There are three degrees of severity of the local reaction. A weak reaction is considered to be hyperemia without infiltrate or infiltrate with a diameter of up to 2.5 cm; an average reaction is an infiltrate of up to 5 cm, a strong reaction is an infiltrate of more than 5 cm, as well as an infiltrate with lymphangitis and lymphadenitis. The occurrence of such reactions is based on an increase in vascular permeability, as well as the development of basophilic infiltration under the influence of an adjuvant. When they occur, they are prescribed antihistamines, compresses.

When live bacterial vaccines are administered, specific local reactions develop due to infectious process at the site of application of the drug. Thus, with intradermal immunization with the BCG vaccine, after 6-8 weeks at the injection site, a specific reaction develops in the form of an infiltrate with a diameter of 5-10 mm with a small nodule in the center and the formation of a crust; in some cases, pustules appear at the injection site. The reverse development of changes takes 2 - 4 months. A superficial scar of 3–10 mm remains at the site of the reaction. If a local atypical reaction occurs, the child needs to consult a phthisiatrician.

GENERAL Vaccinal Reactions are accompanied by changes in the child’s condition and behavior. They often express

there are temperature rise body, anxiety, sleep disturbance, anorexia, myalgia.

After introduction inactivated vaccines general reactions develop after a few hours; their duration usually does not exceed 48 hours. The severity of the reaction is assessed by the height of body temperature, with which other manifestations are directly correlated. The reaction is considered weak when body temperature rises to 37.5 °C, moderate - when body temperature rises from 37.6 to 38.5 °C, strong - when body temperature rises above 38.5 °C. These manifestations are based on the development of an acute phase response.

In children with perinatal damage to the nervous system, an encephalic reaction may develop after vaccination, accompanied by an increase in body temperature and short-term convulsions. A manifestation of such a reaction to the administration of pertussis vaccine is also the child’s continuous high-pitched scream for several hours. The mechanism of development of the encephalic reaction is due to increased permeability vascular wall, the consequence of which is an increase in intracranial pressure and the development of edema-swelling of the brain.

Most often, encephalic reactions develop after vaccination with whole-cell pertussis vaccine, which is associated with its sensitizing effect and the presence of antigens that cross-react with brain tissue. At the same time, the frequency of seizures after the DTP vaccine is lower than that of foreign analogues.

Therapy for encephalic post-vaccination reactions is similar to therapy for neurotoxicosis (see Chapter 6). Manifestations of general reactions to vaccination include: allergic rash. When it occurs, antihistamines are indicated.

4.6.2. Post-vaccination complications

No. 157-FZ “On immunoprophylaxis of infectious diseases”

To Post-vaccination complications include severe and/or persistent health problems that develop as a result of preventive vaccinations(Table 4.3). Post-vaccination complications are divided into specific, depending on the type of microorganism contained in the vaccine, and non-specific.

Cases of post-vaccination complications and suspicions of them, presented in Table. 4.3, are investigated by commissions (pediatrician, therapist, immunologist, epidemiologist, etc.) appointed by the chief physician of the State Sanitary and Epidemiological Supervision center in a constituent entity of the Russian Federation.

Specific post-vaccination complications. Among such complications are vaccine-associated infections caused by the residual virulence of the vaccine strain, the reversion of its pathogenic properties and disorders in the immune system (primary immunodeficiencies).

Table 4. 3

Major diseases in the post-vaccination period that are subject to registration and investigation

	Clinical form
				appearance
	Anaphylactic shock,		Everything except BCG and oral
	anaphylactoid		polio
	reaction, collapse
	Heavy generators		All except BCG and
	lysed allergies		oral polio
	logical reactions		cast vaccine
	Serum syndrome		All except BCG and
			oral polio
			cast vaccine
	Encephalitis, encephalitis		Inactivated
	lopatia, myelitis, ence
	phalomyelitis, neuritis,
	polyradiculoneuritis,
	Guillain-Barre syndrome
	Serous meningitis
	Afebrile seizures		Inactivated
		myocarditis,
		hypoplastic
	anemia, agranus
		Thrombocyto
	singing, collagenosis
	Vaccine-associated		Live polio
	polio
	Chronic arthritis		Rubella
	Cold abscess			During
		lymphadenitis,
	BCinfection
	Sudden death and others
	deaths

Persistent and generalized BCG infection This is the development of osteitis (proceeding as bone tuberculosis), lymphadenitis (two or more localizations), subcutaneous infiltrates. In case of generalized infection, polymorphic clinical manifestations. In persons with primary combined immunodeficiencies, death is possible.

With the development of BCG infection, etiotropic therapy is carried out. For generalized BCG infection, isoniazid or pyrazinamide is prescribed for 2 to 3 months. For purulent lymphadenitis, a puncture of the affected lymph node with the removal of caseous masses and streptomycin or other anti-tuberculosis drugs are administered in a dose appropriate to the age. The same therapy is indicated for cold abscesses that have developed as a result of a violation of the vaccination technique and subcutaneous administration of the BCG vaccine.

Complications after BCG vaccination are rare. Thus, regional BCG lymphadenitis is recorded with a frequency of 1:1000, generalized BCG infection - 1:1000.

Diagnosis of vaccine-associated polio is placed on the basis of criteria proposed by WHO:

a) occurrence within a period of 4 to 30 days in vaccinated people, up to 60 days in contact people;

b) development of flaccid paralysis or paresis without sensory impairment and with residual effects after 2 months of illness;

c) absence of disease progression; d) isolation of the vaccine strain of the virus and increase in titer

type-specific antibodies by at least 4 times.

In countries with high vaccination coverage, the majority of polio cases are modern conditions may be regarded as vaccine-associated. Vaccine-associated poliomyelitis occurs in one child out of 500,000 children vaccinated with oral polio vaccine. In Russia, since 1997, from 2 to 11 cases of vaccine-associated liomyelitis have been reported annually, which on average does not exceed the scope of international statistics (O. V. Sharapova, 2003).

A complication such as encephalitis occurs in a ratio of 1:1,000,000 when vaccinated with both inactivated and live vaccines.

Mitigated measles, post-vaccination measles encephalitis, subacute sclerosing panencephalitis and measles pneumonia may occur after vaccination with measles vaccine.

Acute mumps and mumps meningitis develop after vaccination with mumps vaccine.

Arthritis and arthralgia may occur after administration of red

nushny vaccine; congenital rubella syndrome, termination of pregnancy - when vaccinating pregnant women with rubella vaccine.

Nonspecific post-vaccination complications. Such complications are associated primarily with the individual reactivity of the vaccinated person. Vaccination may act as a detection factor genetic predisposition vaccinated, and post-vaccination complications themselves in young children are predictors of the subsequent development of immunopathological diseases. According to the leading mechanism of occurrence, these complications can be divided into three groups: allergic (atopic), immune complex, autoimmune.

TO allergic complications include anaphylactic shock, severe generalized allergic reactions (Quincke's edema, Stevens-Johnson syndrome, Lyell's syndrome, erythema multiforme exudative), onset and exacerbation of atopic dermatitis, bronchial asthma.

Allergies that occur during vaccination are associated with increased production of general and specific IgE both to the protective antigens of the vaccine and to antigens that do not have a protective effect (egg white, antibiotics, gelatin). Allergic reactions occur to a greater extent in individuals predisposed to atopy. Isolated cases of severe local (including edema, hyperemia more than 8 cm in diameter) and general (including temperature more than 40 ° C, febrile convulsions) reactions to vaccination, as well as mild manifestations of skin and respiratory allergies are subject to registration in the prescribed manner without informing higher health authorities.

The most severe complication group is anaphylactic shock. When a vaccine allergen is ingested parenterally, skin hyperemia and itching (primarily of the hands, feet, groin area), sneezing, abdominal pain, urticarial rash, angioedema. Laryngeal edema, broncho- and laryngeal obstruction may also occur. Blood pressure decreases, muscle hypotension, loss of consciousness, severe pallor of the skin, heavy sweating, foam at the mouth, incontinence of urine and feces, convulsions, coma appear. When anaphylactic shock develops, death can occur within a few minutes. The following steps need to be taken very quickly:

1) immediately stop administering the vaccine that caused the reaction and place the child on his side to avoid asphyxia as a result of aspiration of vomit and retraction of the tongue. If there is no vomiting, the patient is placed on his back and the lower part of the body is raised. The patient is covered with heating pads and access is provided fresh air, cross-country ability respiratory tract, carry out oxygen therapy;

2) immediately administer adrenaline at the rate of 0.01 mcg/kg, or 0.1 ml per year of life up to 4 years, 0.4 ml for children 5 years old, 0.5 ml 0.1%

solution intravenously for children over 5 years of age (subcutaneous or intramuscular administration is possible). Injections are repeated every 10 - 15 minutes until the patient is removed from serious condition. To reduce the absorption of the vaccine when administered subcutaneously, it is necessary to inject the injection site with a solution of adrenaline (0.15 - 0.75 ml of a 0.1% solution). A tourniquet is applied above the injection site

With to slow down the distribution of vaccine antigen;

3) parenterally administer GCS (prednisolone 1 - 2 mg/kg or hydrocortisone 5 - 10 mg/kg), which reduce or prevent the development of later manifestations of anaphylactic shock (bronchospasm, edema). A child in very serious condition can be given 2-3 single doses. If necessary, injections are repeated;

4) parenterally administer antihistamines (diphenhydramine, chloropyramine, clemastine), but only with a clear tendency to normalize blood pressure. In this case single dose diphenhydramine in children from 1 month to 2 years is 2 - 5 mg, from 2 to 6 years - 5-15 mg, from 6 to 12 years - 15 - 30 mg; single dose of chlorpyr-

amine in children under 1 year is 6.25 mg, from 1 year to 7 years - 8.3 mg, from 7 to 14 years - 12.5 mg; Clemastine is prescribed intramuscularly to children in a single dose of 0.0125 mg/kg (daily dose - 0.025 mg/kg).

To restore the volume of circulating fluid, infusion therapy with colloid and (or) crystalloid is carried out.

ny solutions (5 - 10 ml/kg). In case of difficulty breathing or bronchospasm, a solution of aminophylline is prescribed at the rate of 1 mg/kg per hour. In case of development of heart failure, cardiac glycosides are indicated. After emergency care is provided, the patient is subject to mandatory hospitalization.

Vaccination may lead to initiation and/or exacerbation of immunocomplex And autoimmune diseases. The former include hemorrhagic vasculitis, serum sickness, polyarteritis nodosa, glomerulonephritis, and idiopathic thrombocytopenic purpura.

The autoimmune mechanism has post-vaccination complications with damage to the central and peripheral nervous system. Damage to the central nervous system is expressed in the development of encephalitis, encephalomyelitis. When the peripheral nervous system is damaged, mononeuritis, polyneuritis, and Guillain-Barré syndrome may occur. In addition, “second” diseases develop as complications of vaccination: autoimmune hemolytic anemia, idiopathic and thrombotic thrombocytopenic purpura, myocarditis, glomerulonephritis, tubulointerstitial nephritis, systemic lupus erythematosus (SLE), dermatomyositis, systemic scleroderma, juvenile rheumatoid arthritis, multiple sclerosis. Administration of vaccines can stimulate the formation of autoantibodies, autoreactive lymphocytes, immune

Post-vaccination reactions are those that occur after a preventive or therapeutic vaccination.

They are usually due to the following reasons:

– introduction of a foreign biological substance into the body;

– the traumatic effect of vaccination;

– exposure to vaccine components that are not important in the formation of a specific immune response: preservative, sorbent, formaldehyde, residues of the growing medium and other “ballast” substances.

Responders develop characteristic syndrome in the form of general and local reactions. In heavy and moderate severity In cases, performance may be reduced or temporarily lost.

General reactions: increased body temperature, feeling unwell, headache, sleep disturbances, appetite, pain in muscles and joints, nausea and other changes that can be detected using clinical and laboratory examination methods.

Local reactions can manifest themselves in the form of pain at the injection site, hyperemia, edema, infiltration, lymphangitis, as well as regional lymphadenitis. With aerosol and intranasal methods of drug administration, local reactions can develop in the form of catarrhal manifestations of the upper respiratory tract and conjunctivitis.

With the oral (by mouth) method of vaccination, possible reactions (in the form of nausea, vomiting, abdominal pain, stool upset) can be classified as both general and local reactions.

Local reactions can manifest themselves as individual of these symptoms, or all of them. Particularly high local reactogenicity is characteristic of vaccines containing sorbent when administered using the needle-free method. Pronounced local reactions largely determine the intensity of the body’s overall reaction.

General reactions when administered with killed vaccines or toxoids reach their maximum development 8-12 hours after vaccination and disappear after 24 hours, less often - after 48 hours. Local reactions reach their maximum development after 24 hours and usually last no more than 2-4 days . When using sorbed drugs administered subcutaneously, the development of local reactions proceeds more slowly, maximum reactions are observed 36-48 hours after vaccination, then the process enters the subacute phase, which lasts up to 7 days and ends with the formation of a subcutaneous painless compaction (“vaccine depot”) , dissolving in 30 days or more.

When immunizing with toxoids, the scheme of which consists of 3 vaccinations, the most intense general and local reactions of a toxic nature are observed during the first vaccination. Repeated immunization with drugs of a different type may be accompanied by more severe reactions of an allergic nature. Therefore, if severe general or local reactions occur during the initial administration of the drug in a child, it is necessary to register this fact in his vaccination card and subsequently not carry out this vaccination.

General and local reactions during the administration of live vaccines appear in parallel with the dynamics of the vaccination process, while the severity, nature and time of occurrence of reactions depend on the characteristics of the development of the vaccine strain and the immunological status of the vaccinee.

General reactions of the body are assessed mainly by the degree of increase in body temperature as the most objective and easily recorded indicator.

The following scale for assessing general reactions has been established:

– a weak reaction is recorded at a body temperature of 37.1-37.5 ° C;

– average reaction - at 37.6-38.5 °C;

– strong reaction - when body temperature rises to 38.6 ° C and above.

Local reactions are assessed by the intensity of development of inflammatory and infiltrative changes at the site of drug administration:

– an infiltrate with a diameter of less than 2.5 cm is a weak reaction;

– from 2.5 to 5 cm - reaction medium degree;

– more than 5 cm - strong local reaction.

Strong local reactions include the development of massive edema more than 10 cm in diameter, which sometimes forms when sorbed drugs are administered, especially using a needle-free injector. Post-vaccination development of infiltrate, accompanied by lymphangitis and lymphadenitis, is also regarded as a strong reaction.

Data on the reactogenicity of the vaccine used are entered in the appropriate column of the vaccinated person’s medical record. After each vaccination, strictly set time The doctor should evaluate the reaction of the vaccinated person to the injection of the drug, and record the post-vaccination reaction or its absence. Such marks are strictly required when using live vaccines, reactions to the introduction of which are an indicator of the vaccine’s effectiveness (for example, when vaccination against tularemia).

Considering that the severity of vaccination reactions is largely determined by the intensity and duration of the fever, they use modern methods prevention and treatment of post-vaccination reactions. For this purpose, antipyretic drugs are used (paracetamol, acetylsalicylic acid, brufen (ibuprofen), ortofen (voltaren), indomethacin and other drugs from the class of non-steroidal anti-inflammatory drugs). Of these, the most effective are voltaren and indomethacin.

Prescribing medications in the post-vaccination period can significantly reduce the severity of vaccination reactions when using highly reactogenic drugs
or completely prevent their development during immunization with weakly reactogenic vaccines. At the same time, it improves significantly functional state the body and the performance of vaccinated individuals is maintained. The immunological effectiveness of vaccination is not reduced.

The drugs should be prescribed in therapeutic doses, simultaneously with vaccination and until the disappearance of the main clinical symptoms vaccination reactions, but for a period of at least 2 days. It is also extremely important to take medications regularly (3 times a day).

Irregular use of pharmacological agents or their administration late (more than 1 hour after vaccination) is fraught with complications clinical course post-vaccination reaction.

Therefore, if it is impossible simultaneous use vaccines and medications should be prescribed only to persons with already developed reactions, i.e., treatment of vaccination reactions should be carried out, which should last at least 2 days.

Possible post-vaccination complications, their prevention and treatment

Post-vaccination complications are not typical for the normal course of the vaccination process. pathological reactions, causing pronounced, sometimes severe, dysfunctions of the body. Post-vaccination complications are extremely rare.

The main cause of post-vaccination complications is the altered (or perverted) reactivity of the body prior to vaccination. The body's reactivity may be reduced due to the following reasons:

– due to constitutional features;

– due to the characteristics of the allergy history;

– due to the presence of chronic foci of infection in the body;

- due to postponed acute illness or injury;

- in connection with others pathological conditions, weakening the body and promoting it hypersensitivity to allergens.

A standard vaccine preparation introduced into the body, as a rule, cannot cause post-vaccination complications, since it is subject to reliable multi-stage control before release.

A prophylactic drug during the procedure for its administration can be the direct cause of a post-vaccination complication if the vaccination technique is violated (incorrect dose (volume), method (place) of administration, violation of asepsis rules) or when using a drug that was stored in violation of the established regime. For example, an increase in the dose of the administered vaccine, in addition to gross errors, can occur when the sorbed drugs are poorly mixed, when people immunized with the last portions receive an excess amount of sorbent, and therefore antigens.

Severe reactions in the nature of post-vaccination complications can occur when a number of live vaccines are administered to people who are sensitized to this infection (tularemia, brucellosis, tuberculosis) and have not been examined with skin tests allergic status.

Anaphylactic shock

The causes of the acute development of endotoxic or anaphylactic shock may be sensitization of the body, violations of the rules of storage and transportation of a number of vaccines, which lead to increased decay of bacterial cells of live vaccines and desorption of components in sorbed preparations. The administration of such drugs is accompanied by rapid entry into circulatory system excess amounts of toxic products resulting from cell breakdown and modified allergens.

The most reliable and effective way to prevent post-vaccination complications is mandatory compliance with the rules of vaccination at all stages, starting with control of vaccine preparations, competent selection of persons,
subject to vaccination, examining them immediately before the procedure and ending with monitoring the vaccinated in the post-vaccination period.

The medical service must be prepared to provide emergency care in the event of acute post-vaccination complications, fainting or collapsing reactions not related to the effect of the vaccine. To do this, in the room where vaccinations are carried out, medications and instruments necessary to assist with anaphylactic shock (adrenaline, ephedrine, caffeine, antihistamines, glucose, etc.) must always be ready.

An extremely rare, but most severe post-vaccination reaction is anaphylactic shock, which develops as an immediate allergic reaction.

Clinic

The clinical picture of anaphylactic shock is characterized by rapidly developing disorders of the central nervous system, progressive acute vascular insufficiency (collapse, then shock), respiratory disorders, and sometimes convulsions.

The main symptoms of shock are; severe general weakness, anxiety, fear, sudden redness and then paleness of the face, cold sweat, pain in the chest or abdomen, weakening and increased heart rate, a sharp decrease in blood pressure, sometimes nausea and vomiting, loss and confusion, dilated pupils.

Treatment

If signs of shock appear, it is necessary to urgently perform the following actions:

– immediately stop administering the drug;

– apply a tourniquet to your arm (if the drug was injected into it, this will prevent the drug from spreading throughout the body);

– put the patient on the couch, give a pose with his head bowed low;

– vigorously warm the patient (cover with a blanket, apply heating pads, give hot tea);

- provide him with access to fresh air;

– inject 0.3-0.5 ml of adrenaline (in 2-5 ml of isotonic solution) into the injection site and 0.3-1.0 ml additionally subcutaneously (in severe cases - intravenously, slowly).

In very severe conditions, intravenous drip administration of a 0.2% solution of norepinephrine in 200-500 ml of a 5% glucose solution is indicated at the rate of 3-5 ml of the drug per 1 liter. At the same time, an antihistamine (diphenhydramine, diazolin, tavegil, clemastine, etc.), calcium chloride is administered intramuscularly, cordiamine, caffeine or ephedrine is administered subcutaneously. In acute heart failure - intravenously 0.05% strophanthin from 0.1 to 1 ml in 10-20 ml of 20% glucose solution, slowly. The patient must be given oxygen.

If there is no result from these measures, hormonal drugs are used intravenously (3% prednisolone or hydrocortisone in a 20% glucose solution).

Persons with developed anaphylactic shock are hospitalized at the first opportunity in a hospital using special intensive care transport. If such a patient is not provided with timely health care, anaphylactic shock can be fatal.

Endotoxic shock

Clinic

Endotoxic shock is extremely rare with the introduction of live, killed and chemical vaccines. His clinical picture resembles anaphylactic shock, but it develops more slowly. Sometimes hyperemia with severe intoxication can quickly develop. In these cases, the administration of antipyretic, cardiac, detoxification and other drugs is indicated. Immediate hospitalization of the patient is necessary.

Allergic reactions from the skin are more often observed with the introduction of live vaccines and manifest themselves in the form of extensive hyperemia, massive edema and infiltration. A variety of rashes appear, swelling of the mucous membranes of the larynx, gastrointestinal tract and mouth may occur. These phenomena occur soon after vaccination and, as a rule, pass quickly.

Treatment

Treatment consists of prescribing antihistamines and anti-itch medications. The use of vitamins A and group B is indicated.

Neurological post-vaccination complications

Neurological post-vaccination complications can occur in the form of lesions of the central (encephalitis, meningoencephalitis) and peripheral (polyneuritis) nervous system.

Post-vaccination encephalitis is an extremely rare phenomenon and is most often observed in children who are vaccinated with live viral vaccines. Previously, they most often occurred during immunization with the smallpox vaccine.

Local post-vaccination complications include changes that are observed during subcutaneous administration of sorbed drugs, especially when using a needle-free injector, and occur as a cold aseptic abscess. Treatment of such infiltrates comes down to physiotherapeutic procedures or surgery.

In addition to the complications listed above, other types may also occur. post-vaccination pathology, associated with an exacerbation of the underlying disease that the vaccinated person suffered from, which occurred in a latent form.

Chapter 2 Post-vaccination reactions and complications

When carrying out mass immunization of adults and children, the safety of vaccines and a differential approach to the selection of persons to be vaccinated are of great importance.

Correct organization of vaccination work requires strict consideration of vaccination reactions and post-vaccination complications. Vaccinations should only be carried out medical workers in special vaccination rooms.

Reactions to vaccinations are an expected state of the body, which may be characterized by deviations in the nature of its functioning. Often, local and general reactions may occur during parenteral administration of the vaccine.

Local reactions develop in the area of ​​vaccine administration in the form of redness or infiltration. They appear more often in older children and adults. In most cases, prolonged local reactions occur when using adsorbed vaccines.

The general reaction is manifested by increased temperature, headache and joint pain, general malaise, and dyspeptic symptoms.

The response to the vaccine depends on the individual characteristics of the organism and the reactogenicity of the vaccine. In case of severe reactions in more than 7%, the vaccine used is withdrawn.

In addition, reactions to the introduction of vaccines differ in the time of their occurrence. An immediate reaction can occur after any vaccine.

It is often observed in people who previously had damage to the respiratory system, nervous system, or who had influenza or adenoviral infection before vaccination. This reaction occurs within the first 2 hours after vaccination.

An accelerated reaction develops in the first day after administration of the vaccine and is expressed in local and general manifestations: hyperemia at the injection site, tissue swelling and infiltration. There are weak (diameter of hyperemia and induration up to 2.5 cm), medium (up to 5 cm) and strong (more than 5 cm) accelerated reactions.

A vaccine reaction, manifested by symptoms of general severe intoxication or damage to individual organs and systems, is regarded as a post-vaccination complication.

Post-vaccination complications are rare. Certain local reactions are subject to registration during vaccinations (Table 19).

Table 19. Post-vaccination local reactions

Post-vaccination complications are divided into several groups.

Complications associated with violation of vaccination technique, which are rare, include suppuration at the injection site.

In the case of subcutaneous administration of adsorbed vaccines, aseptic infiltrates are formed. Subcutaneous administration of the BCG vaccine can lead to the development of an abscess accompanied by lymph node involvement.

Complications related to the quality of the vaccine can be local or general.

In addition, complications can develop in cases of exceeding the dosage of the drug used, subcutaneous administration of vaccines used for the prevention of especially dangerous infections, as well as those intended for skin vaccinations.

Such errors during vaccinations can cause severe reactions with a possible fatal outcome.

If the dose of inactivated and live bacterial vaccines is exceeded by more than 2 times, the administration of antihistamines is recommended; if the condition worsens, prednisolone is prescribed parenterally or orally.

If an overdose of mumps, measles and polio vaccines is administered, treatment is not required. Special training medical personnel who carries out vaccination prevents these complications, which are not always a pathological condition.

To decide whether the process that arose in the post-vaccination period is a complication of the vaccination, it is necessary to take into account the time of its development (Table 20). This is also important for determining the criterion for insurance liability.

Table 20. Possible post-vaccination complications (V.K. Tatochenko, 2007)

During the vaccination period (both on the day of vaccination and in the days following immunization), a vaccinated person, especially a child, may experience various diseases that are mistaken for post-vaccination complications.

But the occurrence of disease symptoms after vaccination is not always a consequence of vaccination.

Deterioration of the condition 2–3 or 12–14 days after vaccination with inactivated drugs, as well as with live viral vaccines, is often associated with the appearance of various diseases infectious order (ARVI, enterovirus infection, urinary tract infection, intestinal infections, acute pneumonia, etc.).

In these cases, urgent hospitalization of the patient is necessary to clarify the diagnosis.

Non-communicable diseases (various diseases digestive tract, renal pathology, respiratory diseases) occur in only 10% of total number similar cases.

Approximate criteria are the timing of appearance individual symptoms after vaccinations.

General severe reactions, accompanied by fever and convulsions, occur no later than 2 days after vaccination (DPT, ADS, ADS-M), and with the introduction of live vaccines (measles, mumps) no earlier than 5 days.

A response to live vaccines, with the exception of immediate reactions, can be detected immediately after vaccination in the first 4 days, after measles - more than 12-14 days, mumps - after 21 days, after polio vaccine - 30 days.

Meningeal symptoms may appear 3–4 weeks after administration of the mumps vaccine.

The phenomena of encephalopathy as a reaction to the administration of a vaccine (DPT) are rare.

Catarrhal symptoms may occur after the measles vaccine is administered - after 5 days, but no later than 14 days. Other vaccines do not have this reaction.

Arthralgia and isolated arthritis are characteristic of rubella vaccination.

Vaccine-associated poliomyelitis develops on days 4–30 after immunization in vaccinated people and up to 60 days in contact people.

Anaphylactic shock

Anaphylactic shock is a severe generalized immediate reaction caused by an antigen-antibody reaction occurring on the membranes of mast cells with fixed antibodies (JgE). The reaction is accompanied by the appearance of biologically active substances.

Anaphylactic shock usually occurs 1–15 minutes after parenteral administration of vaccines and serums, as well as during allergy testing and allergen immunotherapy. It develops more often with subsequent vaccinations.

Initial clinical manifestations occur immediately after administration of the vaccine: anxiety, palpitations, paresthesia, itching, cough, and difficulty breathing.

Usually, with shock, hypoexcitement develops due to a sharp expansion of the vascular bed due to vasomotor paralysis.

In this case, the permeability of membranes is impaired, interstitial edema of the brain and lungs develops. Oxygen starvation sets in.

Anaphylactic shock is accompanied by dysfunction of the central nervous system, the appearance of a threadlike pulse, pallor skin, decrease in body temperature. Anaphylactic shock can often be fatal.

In the development of anaphylactic shock, 4 stages are observed: the stage of sensitization, immunokinetic, pathochemical and pathophysiological.

Cases of death within 1 hour are usually associated with collapse, within 4–12 hours - with secondary circulatory arrest; on the second day and later - with progression of vasculitis, renal or liver failure, cerebral edema, damage to the blood coagulation system.

Clinical variants of anaphylactic shock can be different. Treatment measures are associated with their manifestations.

At hemodylactic option Treatment is aimed at maintaining blood pressure; vasopressors, plasma replacement fluids, and corticosteroids are prescribed.

Asphyxial variant requires the administration of bronchodilators, corticosteroids, sputum suction, elimination of respiratory disorders (elimination of tongue retraction, tracheostonia). Oxygen therapy is also prescribed.

Cerebral variant involves the prescription of diuretics, anticonvulsants and antihistamines.

Abdominal option requires repeated administration of sympathomimetics, corticosteroids, antihistamines and diuretics.

List of medications and medical equipment necessary to assist with anaphylactic shock

1. 0.1% solution of adrenaline hydrochloride – 10 ampoules.

2. 0.2% solution of norepinephrine hydrotartate – 10 ampoules.

3. 1% mesatone solution – 10 ampoules.

4. 3% prednisolone solution – 10 ampoules.

5. 2.4% aminophylline solution – 10 ampoules.

6. 10% glucose solution – 10 ampoules.

7. 5% glucose solution – 1 bottle (500 ml).

8. 0.9% sodium chloride solution – 10 ampoules.

9. 0.1% solution of atropine sulfate – 10 ampoules.

10. 10% calcium chloride solution – 10 ampoules.

11. 2% solution of suprastin – 10 ampoules.

12. 2.5% solution of pipalfen – 10 ampoules.

13. 0.05% solution of strophanthin – 10 ampoules.

14. 2% solution of furaselide (Lasix) – 10 ampoules.

15. Ethyl alcohol 70% – 100 ml.

16. Oxygen cylinder with reducer.

17. Oxygen cushion.

18. System for intravenous infusion- 2 pcs.

19. Disposable syringes (1, 2, 5, 10 and 20 ml).

20. Rubber bands – 2 pcs.

21. Electric suction – 1 pc.

22. Mouth retractor – 1 pc.

23. Device for measuring blood pressure.

Measures taken during anaphylactic shock

1. The patient must be positioned so that his head is below the level of his legs and turned to the side to prevent aspiration of vomit.

2. Using a mouth expander, the lower jaw is advanced.

3. Immediately administer adrenaline hydrochloride 0.1% or norepinephrine hydrotartrate in an age-specific dosage (children 0.01, 0.1% solution per 1 kg of weight, 0.3–0.5 ml) subcutaneously or intramuscularly, and also carry out injections or local injections.

4. Blood pressure is measured before the administration of adrenaline and 15–20 minutes after administration. If necessary, the injection of adrenaline (0.3–0.5) is repeated and then administered every 4 hours.

5. If the patient’s condition does not improve, intravenous administration of adrenaline (epinephrine) is prescribed: 1 ml of 0.1% solution in 100 ml of 0.9% sodium chloride. Inject slowly - 1 ml per minute, under the control of counting heart rate and blood pressure.

6. Bradycardia is stopped by administering atropine at a dose of 0.3–0.5 mg subcutaneously. According to indications in case of severe condition, the administration is repeated after 10 minutes.

7. To maintain blood pressure and replenish the volume of circulating fluid, dopamine is prescribed - 400 mg per 500 ml of 5% glucose solution, with further administration of norepinephrine - 0.2–2 ml per 500 ml of 5% glucose solution after replenishing the circulating volume liquids.

8. If there is no effect from infusion therapy, it is recommended to administer glucagon (1–5 mg) intravenously as a bolus, and then as a bolus (5–15 mcg/min).

9. To reduce the intake of antigen, a tourniquet is applied to the limb above the injection site for 25 minutes, loosening every 10 minutes for 1–2 minutes.

10. Antiallergic drugs are administered intravenously or intramuscularly: half daily dose prednisolone (3–6 mg/kg per day for children), if indicated, this dose is repeated or dexamethasone (0.4–0.8 mg/day) is prescribed.

11. The administration of glucocorticoids is combined with the administration of antihistamines intramuscularly or new generation drugs orally.

12. In case of laryngeal edema, intubation or tracheostomy is indicated.

13. In case of cyanosis and dyspnea, oxygen is given.

14. In case of terminal condition, resuscitation is carried out by indirect massage, administration of adrenaline intracardially, as well as artificial ventilation lungs, intravenous administration of atropine and calcium chloride.

15. Patients with anaphylactic shock are subject to immediate hospitalization in the intensive care unit.

Feverish reaction

Hyperthermic syndrome

A reaction without a visible focus of infection can be observed 2–3 days after DPT administration and 5–8 days after measles vaccination. An increase in temperature should be alarming if the condition worsens and signs of bacterial inflammation appear.

As a result, the current vaccination reaction stimulated by the production of pyrogenic cytokines, such as interferon gamma, interleukin, prostaglandin E, etc., which act on the pituitary gland and thereby lead to a decrease in heat transfer.

At the same time, specific antibodies of class G and memory cells are produced. Fever that occurs after vaccinations is usually well tolerated.

Indications for use medications are a body temperature of 39 °C in children over 3 months old, as well as convulsive syndrome, diseases of the central nervous system, cardiac decompensation at a body temperature of more than 38 °C. In the presence of muscle pain and headaches, the prescription of antipyretics is 0.5 lower than indicated.

Among antipyretics, it is recommended to prescribe paracetamol in a single dose of 15 mg/kg body weight, 60 mg/kg/day. Typically, its effect occurs within 30 minutes and lasts up to 4 hours. In addition to prescriptions in solution, you can use it in suppositories (15–20 mg/kg).

To quickly reduce the temperature, the introduction of a lytic mixture consisting of 0.5–1 ml of 2.5% aminazine (chlorpromazine), pipolfen is used. It is also possible to administer analgin (metamizole sodium) at 0.1–0.2 ml of a 50% solution per 10 kg of body weight.

In case of hyperthermia, the child is placed in a well-ventilated room, a constant supply of fresh cool air is ensured, prescribed drinking plenty of fluids(80–120 ml/kg/day) in the form of glucose-saline solution, sweet tea, fruit juices. The child is given frequent and frequent drinks.

In case of hyperthermia, use physical methods cooling - open the child, hang an ice pack over his head.

These procedures are indicated for hyperthermia, which occurs with redness of the skin, in which case increased heat transfer occurs.

For hyperthermia, accompanied by pallor of the skin, chills, vasospasm, the skin is rubbed with 50% alcohol, papaverine, aminophylline, no-shpu are given.

Encephalic syndrome

This syndrome is accompanied by impaired cerebral circulation, agitation, and single short-term convulsions. Usually does not require active therapy.

If the convulsive syndrome persists, urgent hospitalization is indicated.

Diazepam is urgently administered (0.5% solution intramuscularly or intravenously at 0.2 or 0.4 mg/kg per injection).

If the convulsions do not stop, repeated administration is made (0.6 mg/kg after 8 hours) or diphenine is administered at a rate of 20 mg/kg. With persistent convulsive syndrome Other agents are also used (sodium hydroxybutyrate, valproic acid, etc.).

Collapse

Collapse is an acute vascular failure, which is accompanied by sharp decline vascular tone, symptoms of brain hypoxia. Collapse develops in the first hours after vaccination. Characteristic symptoms are lethargy, adynamia, pallor with marbling, severe acrocyanosis, rapid decline blood pressure, weak pulse.

Emergency assistance consists of immediately taking the following measures. The patient lies on his back, with his head thrown back to ensure an influx of fresh air. The airway is ensured and an audit is carried out oral cavity. The patient is administered a 0.1% solution of adrenaline (0.01 ml/kg), prednisolone (5–10 mg/kg/day) intravenously or intramuscularly. This text is an introductory fragment.

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Post-vaccination reactions.

Local reactions– in the form of hyperemia with soft tissue swelling at the injection site up to 3 cm in diameter.

General reactions– in the form of an increase in temperature to 39.5ºС.

Allergic reactions– in children with allergies may worsen skin syndrome, exudative manifestations intensify.

Neurological reactions- in children with neurological pathology manifested by motor disinhibition, tearfulness, and restless sleep.

Post-vaccination reactions occur quite often (1-5%), do not pose a threat to life and health, do not require urgent measures, and are registered only in the territorial center of Rospotrebnadzor. The nature of the reactions is noted in the preventive vaccination card (form No. 063/u) and development history (form No. 112/u).

Post-vaccination complications.

Heavy local manifestations in the form of dense infiltrates more than 8 cm in diameter.

Overly strong general reactions in the form of fever 39.6ºС or more, febrile convulsions.

Allergic complications: acute urticaria, angioedema, anaphylactic shock. In children of the first year of life, the equivalent of anaphylactic shock is a collaptoid state: paleness, cyanosis, severe lethargy, drop in blood pressure, the appearance of sticky sweat, and sometimes loss of consciousness.

Neurological complications:

a continuous high-pitched “brain” scream (squeal) lasting for several hours, associated with increased intracranial pressure;

afebrile convulsions with loss of consciousness, sometimes in the form of “nods”, “pecking”, “absences”, stopping of gaze;

encephalitis, occurring with convulsions, prolonged loss of consciousness, fever, vomiting, and the development of focal symptoms.

Specific complications:

vaccine-associated polio (after OPV)

generalization of BCG, BCG-itis, regional abscess, osteomyelitis, keloid scar.

Post-vaccination complications are very rare (1:70000 – 1:5000000). A medical institution that has diagnosed a post-vaccination complication must send an emergency notification to the local territorial center of Rospotrebnadzor and to the State Research Institute for Standardization and Control of Medical Biological Preparations named after. L.A. Tarasevich (119002, Moscow, Sivtsev Vrazhek lane, 41). An internal investigation is carried out in each case.

Causes of post-vaccination complications

Complications associated with the disorder vaccination techniques, are few in number. Violations of sterility lead to the development of suppuration at the injection site; Exceeding the dose of the drug can cause severe toxicoallergic reactions.

Complications associated with vaccine quality: local (nonsterility) or general (toxic) - appear in several children vaccinated with the same series of vaccines.

Complications due to individual reaction.

Emergency care for post-vaccination complications at the prehospital stage.

Hyperthermia

The child should be lightly dressed, be in a well-ventilated area and receive plenty of fractional drinks in the amount of 80-120 ml/kg/day.

For hyperthermia with pallor, marbled skin, chills and cool extremities caused by spasm of peripheral vessels, antipyretics are prescribed:

healthy children - upon reaching body temperature > 38.5ºС;

for children with neurological pathology and a history of seizures – temperature >38.0ºС.

Enter paracetamol 10 mg/kg orally or in suppositories, if there is no effect - lytic mixtures intramuscularly:

Metamizole sodium 50% solution: up to 1 year – 0.01 ml/kg, over 1 year – 0.1 ml/year of life;

Diphenhydramine 1% solution (diphenhydramine): up to 1 year – 0.01 ml/kg, over 1 year – 0.1 ml/year of life;

Papaverine hydrochloride 2% - up to 1 year - 0.01 ml/kg; 0.1 ml/year of life;

30-40 minutes after taking or administering antipyretics, the “pale” fever should turn into “pink”, the peripheral vessels will dilate, the skin will become pink, the extremities will be hot, and sweating may begin. At this stage, increased heat transfer occurs, so most often it is enough to undress the child, ensuring the flow of fresh air.

Vaccinations ⇁ are the most reliable way to protect your baby from various deadly diseases. But there are no fewer opponents to vaccinating children than supporters. No matter how much the doctors assure that there is no other more reliable way to protect the baby from polio, tetanus, and tuberculosis, the enemy will insist on their own. On the Internet and in newspapers you can read numerous reviews about terrible, and sometimes even deadly consequences after vaccinations. But is a vaccine reaction as dangerous as opponents say? Let's look at the consequences of vaccinations and what parents can expect.

How does the baby's body react to vaccination?

Any reactions after the vaccine is administered to a child are neither desirable nor dangerous. If the body has responded to the vaccine, then the immune system has formed a defense, and this is the main purpose of vaccinations. In some cases, vaccination is designed to protect not only the vaccinated baby, but also his children, for example, from rubella.

By their nature, all reactions of the child’s body to the administered drug are conventionally divided into two groups:

• Post-vaccination is a normal reaction of a healthy immune system to administered compounds.
• Complications are various unexpected reactions of the body.

Complications after vaccination appear in percentage terms no less frequently than after taking any other medication. And complications after illnesses are many times worse than after immunovaccination. According to statistics from the Ministry of Health, complications after the administered drug during vaccination occur in 1 out of 15,000 cases. And if the drug was stored correctly, the child was thoroughly examined before the procedure and the injection was given at the right time, then this ratio will increase by 50–60%.

Therefore, you should not be afraid of reactions; it is better to understand them and take preventive and auxiliary methods in a timely manner. A prepared baby will tolerate the drug more easily and his immunity will be better formed.

Normal behavior of the body after vaccination

After vaccination, normal reactions develop, which are divided into general and local. Local reactions occur directly at the site of drug administration. Vaccination against various diseases causes local reactions that differ:

• Whooping cough, diphtheria, tetanus - painful infiltration on the skin, with redness.
• Measles, Rubella, Mumps - redness with swelling.
• Mantoux test - compaction with swelling and redness around the infiltrate.
• Poliomyelitis droplets - conjunctivitis, swelling of the nasopharyngeal mucosa.

The local reaction manifests itself and does not cause much concern to specialists. The symptoms go away on their own after 3–4 days and there is no need for additional treatment. But if swelling and itching of the tissues bother the baby, then you can lubricate the skin with antihistamine ointments and give an anti-allergenic drug.

TO general reactions include:

• allergic reaction (redness, itching of the skin on any part of the body);
• slight increase in temperature (up to 38 degrees, easily reduced by antipyretic drugs and goes away in 2-3 days);
• in some cases, slight malaise (the child feels weak, eats poorly and sleeps longer).

The biggest reactions are caused by the BCG vaccine, which is poorly tolerated by a child with reduced immunity. Local reactions themselves are not dangerous for a baby with high immunity, but if the baby is sick in a latent form, then local reactions will become aggravated - complications.

Complications after immunovaccination

The most dangerous reactions after vaccination there are complications. The baby’s body does not tolerate the administered drug well and the child exhibits symptoms:

• From the mental side of the crumbs: irritability, tearfulness, increased fatigue.
• From the stomach: loose stool, nausea, vomiting, pain.
• Hyperthermia, the temperature rises above 38.5 and lasts for several days.
• Allergic reaction: skin rashes, swelling of the nasopharynx, face.

Any of adverse reactions dangerous for the baby. Therefore, when the first signs appear, it is better to notify specialists.

What are the dangers of allergies after vaccination?

Among the most dangerous symptoms is allergic reaction V acute form. It may appear both on the first day and within several days after the administration of the medication. The main reason for a violent allergic reaction is the composition of the drug. Almost all vaccines used in Russia are made on the basis chicken protein. In allergic children, the reaction can cause anaphylactic shock or angioedema. Specialists carefully monitor children with a tendency to allergies and, in some cases, use less aggressive analogues of drugs.

Before vaccinations with DTP and BCG, you need to prepare the baby’s body. Three days before the injection, the child is given antihistamines. Their use is canceled 3-4 days after immunovaccination.

Even if the child did not experience any allergies after the first vaccination, mothers should not relax. After the procedure, you should not leave the clinic immediately. Walk with your baby for 30–40 minutes around the hospital yard. If a severe allergic reaction occurs, doctors will be able to provide first aid in a timely manner.

Hyperthermia after administration of the drug

High temperatures are dangerous for young children. If the thermometer shows above 38.5 degrees for more than 3 hours, then the likelihood of developing febrile seizures increases. Children of any age are susceptible to seizures, but seizures are more likely to occur in children under 2 years of age. Parents should control hyperthermia and not allow it to rise above 38.5.

At BCG vaccination An increase in temperature to 38 degrees in the first three days before vaccination is considered normal. Symptoms will disappear on their own within 3-4 days.

You can alleviate the child’s condition with the help of antipyretic suppositories and medications: feralgon, nurofen, ibuklin, paracetamol. We do not recommend lowering the temperature after vaccination with aspirin and analgin. Drugs affect cardiac function vascular system and you will only harm the baby.

A high fever that lasts for several hours can cause nausea, headaches, and general malaise in a child. If the symptoms are aggravated by a local reaction in the form of an abscess or lump that pulsates, then you should immediately contact an ambulance.

Any reactions, expected or complications, are better than the consequences after an illness. It is possible to prevent unpleasant symptoms after vaccination, but it will be difficult to correct a child’s crippled body. Therefore, we recommend immunovaccination, but before each procedure, the child’s body must be prepared.